MEDICARE: AUTUMN MARTIN APRN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN215533	GA

General Provider Information

NPI Number	:	1891305165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN MARTIN APRN, FNP-BC

Provider Business Mailing Address
First Line	:	1867 CREAT TRL SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4566
Country	:	US
Telephone Number	:	770-316-8738
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S MAIN ST STE 201
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-1975
Country	:	US
Telephone Number	:	470-300-8723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	08/03/2020

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